The Doubt Bully

A VERY unscientific explanation for obsessions and compulsions

Okay, technically speaking, it does; and even they--the top neuroscientists in the country--confess to being somewhat perplexed by the structural and functional anomalies of the OCD brain and the reasons for them. Issues with the caudate nucleus? Problems with serotonin reuptake? Lots of still-inconclusive theories floating around.

I, myself, don't even pretend to understand any of the brain science behind this disorder. I do, however, have an explanation for the obsessions and compulsions that have plagued me and millions of other people with OCD--an explanation to which any kid who's every spent time on a playground can relate.

I say, The source of my OCD is quite simply . . . The Doubt Bully.

Now, lest you fear that this blogger has issues extending far beyond chronic anxiety (and involving imaginary friends), let me assure you that I've never actually "seen" my OCD nemesis. Moreover, in conjuring up my bully, I am merely following the advice of numerous OCD specialists who advocate externalizing one's OCD. In so doing, the thinking goes, an OCD sufferer is able to create an entity that he or she can then stand up to and fight back against. I, myself, have found this approach to be especially helpful, and in my travels I'm hearing from more and more fellow OCD sufferers who have benefited greatly from the concept as well. Interestingly, I'm also finding that my non-OCD friends and readers, too, have their own doubt bullies--the sources of not OCD obsessions and compulsions, but rather everyday fear-based doubts and their counterproductive responses to them. (More on that in future postings.)

So what does The Doubt Bully look like? And how does he operate?

I can only answer for myself, of course. But, in the interest of exploring the mechanics of doubt-bully-ism, allow me to introduce you to my own personal doubt bully, both my original one and my current model--or in the vernacular of our high-tech blogging world, Doubt Bully 1.0 and Doubt Bully 2.0.

Version 1.0 -- "Octi" (The Octopus Chewing Doubt-nuts)

For this early incarnation of my doubt bully I can thank my two daughters. They were still too young to understand the nature of Daddy's challenges when I first started writing about my obsessions and compulsions back in the late 90's, and one day they offered up their own creative expansion of the OCD acronym they'd seen on my notepads: Octopuses Chewing Doughnuts. Although at some point doughnuts morphed into doubt-nuts, the image stuck. And the description worked.

Imagine, if you will, a hungry octopus (the doubt bully). "Octi" (as my daughters later named him) survives on doubt-nuts (compulsions), but needs me to feed them to him. To this end, Octi taunts me with a series of distressing "what-if" questions (that become my obsessions), raising my anxiety until I fall into his trap of performing my compulsions and thereby feeding him said doubt-nuts.

Let's try an example: Octi is hungry. He wants a doubt-nut, so he starts with the "what-ifs." What if your hands aren't clean, Jeff? What if you're unknowingly carrying some horrific virus? The notion agitates me, but not enough to indulge my compulsive urge to scrub my hands. Octi steps up his taunting. What if you get your germs on the keyboard at work and one of your coworkers gets sick and dies? My anxiety is spiking and Octi knows he has me. You can't take that risk, he says. Scrub your hands to make sure everyone will be safe. I know it's a trap, but I fall right into it, heading for the sink and, in so doing, I feed Octi his doubt-nut. (Of course, I'm speaking hypothetically; I know better today!!) Octi is fed now, but--as with each previous time that I've fed him--his stomach only grows bigger. He needs that many more doubt-nuts to satiate his appetite.

Version 2.0 -- "Director Doubt"

Octi came to personify--hmmm, can an octopus "personify"?--my OCD for a lot of years, but in 1997, I stumbled onto an even better image of my own personal doubt bully. I was sitting in a movie theater, watching Peter Weir's brilliant film, The Truman Show, when I realized that the film's eccentric reality show director, Christof, was directing his unwitting star, Truman Burbank, in exactly the same way that my OCD nemesis "directs" me. It was Christof's job to keep poor Truman mired in doubt and fear, and to this end he created one trap after another, distorting reality at every turn, and taunting Truman into compulsive behavior--in his case, avoidance. Isn't that precisely how my doubt bully works??

Whether or not you've seen The Truman Show, I encourage you to rent it soon and see for yourself the uncanny OCD alagory it provides. To this day, my doubt bully (whom I've dubbed Director Doubt) looks a whole lot like Ed Harris (who won an Oscar for his portrayal of Christof.)

Back to the Schoolyard

Here's the good news about bullies: they're seldom as tough as we imagine them to be. Take the kid on the elementary school playground who taunts little Johnny, maybe demanding day after day that he hand over the Oreos in his lunchbox. The more Johnny complies, the more he empowers the bully. Likewise, if Johnny falls into the trap of avoiding his nemesis, steering clear of the schoolyard altogether. But what if Johnny gets fed up one day and--perhaps emboldened by Yard Monitor Mrs. Smith--he simply says No? Chances are, the schoolyard bully backs down. We've all seen that dynamic in action.

To be clear, bullying at schools is an all too serious issue these days; I'm speaking metaphorically here. But I think you get where I'm going with this. The key to dealing with doubt bullies is to: (1) acknowledge their presence, and (2) willfully choose not to comply with their demands.

As anyone with OCD can tell you, this is FAR easier said than done, and it often requires the support of a professional equivalent of Yard Monitor Mrs. Smith. For those of you a step or two ahead of me . . . yes, I am talking about therapist-guided Exposure/Response-Prevention therapy, and we'll pick up there next time.

NOTES:

Thanks for all the great responses and topic suggestions. Keep ‘em coming. This is OUR blog, not mine.

Help spread the word, if you would. Please feel free to email this blog to anyone you think might be interested. (There's a "button" on this page that makes doing so real easy.)

Thanks for your efforts. It was nice meeting you at OCF conference and I feel good that you are doing a great job as the spokesperson.
As a physician and a parent of child with OCD, I feel that medical establishment has done a poor job of OCD diagnosis and treatment and that along with existing stigma prevents a lot of OCD sufferers from getting better. We will work on that aspect in Sacramento.
Thanks again,
Gaurang Desai

“What if” questions, whether you are an OCD suffer or not, can make your life miserable. I am not an OCD sufferer myself, but know firsthand what it is like to live with doubt. There have been a few significant events in my life when I have allowed the “what if” questions to preoccupy my mind and monopolize my thoughts causing me to I miss out on what is going on around me; the important stuff. For example, last year my best friend committed suicide. After being discharged for the third time from an alcohol rehab program, he decided to save his friends and family any further expense and embarrassment, by taking his life. From that day on I have been plagued with “what if” questions: what if I hadn’t given him $20 because I felt sorry for him having no money in rehab – maybe he would not have run away to buy a bottle and fall of the wagon. What if I had not visited him so often, bringing him things to help make his stay more comfortable while in rehab - maybe he would have worked harder to recover and get out. What if I had not told him that when I had a near death experience, and felt myself crossing over, it was the most peaceful feeling I had ever had – Maybe he would have been afraid of death. What if I had gone to see him one last time before he went home...What if I had called sooner....What if? What if?? What if???? - Maybe my friend David would be alive today. Logically, deep down in my heart, I know that I was not responsible for the choice he made, but I can’t stop asking myself the same questions over and over, especially when something triggers a memory. I really wish I could, because it infects so many aspects of my life and often leads to depression. No I don’t have OCD, but I imagine the torment of the “what if” questions is similar to what I experienced – on a much grander scale of course, but I need too need to heed Jeff’s advice and knock out my “doubt bully,” free myself and start living in the here and now. Thanks for sharing Jeff. You are an inspiration :)

I know from experience and listening to my daughter (an OCD sufferer) that the “what if” questions never stop coming. The brain is cruel that way. We have no control over what thoughts pop into our heads. So, the only option we doubters have then is to put the thoughts and questions; the “what ifs” on mute – put duck tape over the bully’s mouth if you will - so we can no longer hear them. If we can’t hear the demands, we can’t act on them. I believe if we ignore the bully long enough that s/he will eventually give up trying and just go away or at least their voice will become less audible. But, we must beware of their return. The bully may we lucking around waiting for the perfect opportunity (when you are struggling) to jump out of the bush with more demands. It is then that we must stay strong....put our fingers in our ears and sing lalalala. The bully will hate that! I am not in a delusional world. I am painfully aware that this is easier said than done. It takes a lot of strength and perseverance, but it will most definitely pay off in the end. You will have your life back. I think that it is great that Jeff personified his doubt bully. We all should – just so you can picture it tied up and gagged in a corner. Good luck!

Every step I take my ocd plauges me. I found this article looking for some answers because a compulsion is eating at me. I would never hurt anyone, but its as if I cant even be mad without a thought of hurting them arises. Its even affected my driving. I always fear I'm running people over that I know or love and theyre not even there. I need help, I have religious ocd and am afraid of the occult. Its as if someone (the bully) or something is out to get me. Ugh, not fun.

Every step I take my ocd plauges me. I found this article looking for some answers because a compulsion is eating at me. I would never hurt anyone, but its as if I cant even be mad without a thought of hurting them arises. Its even affected my driving. I always fear I'm running people over that I know or love and theyre not even there. I need help, I have religious ocd and am afraid of the occult. Its as if someone (the bully) or something is out to get me. Ugh, not fun.

Hi, Bill. I'm sorry to hear that you are suffering. Please know that the help that you recognize you need IS available. I speak from experience when I tell you that OCD is treatable. If you're not sure where to start with treatment, I would recommend visiting the International OCD Foundation web site (www.ocfoundation.org). They have a variety of resources, including a region-by-region directory of treatment providers. I hope this is helpful, and I hope you will actively seek out a qualified OCD therapist who can help you battle your doubt bully!

Bill, I'm hoping you can help. I'm sure my son suffers from OCD, His main issue when stressed is in his words "everything has to be symmetrical". If he touches something with one hand, he has to touch it with the other hand, his sox have to feel the same on both feet, if he looks to the left he has to look to the right, he has his wallet in one pocket then there had to be something in the other etc. Okay with the wallet I made him leave it there and he freaked, then I told him you have a choice you can take only the wallet or if you have to feel even you're not taking anything and you won't be able to get anything at the store (he's nine & had just received his allowance). I told him I know it's hard but you can do it. It actually worked(it was hard at first but now it doesn't bother him at all). But with the touching I haven't found a way to help him stop.Any ideas?
Ps.
I no longer have insurance as I'm laid off, So suggesting therapy at this point is not an option.

I've been through the gamut of the OCD spectrum since I was a child.
I had a severe five year stretch in the 90s. I mean- it's chronic but there are stretches when the disease is very manageable because of the many wonderful strategies that allow us to live with the "uncertainty" to the point that the triggers become background noise.

Yet, of course the monster returns every so often- and the spikes can be triggered by OCD related anxieties or real life events (or a combo of both). Say, someone you know gets and dies from a staph infection and you witness the effects (and you yourself are under a lot of stress- work,etc). Well, that can trigger a HUGE spike that can amplify what was manageable to something unmanageable.

I've had this disease long enough to understand that triggers (real and not) cause real bodily reactions- heart racing, hands shaking, etc ALL panic and anxiety related-- and that the compulsions that follow are our OCD brain's reaction-- we instinctively irrationally think that we can fix it by our repetitive action (pick you poison- checker, washer, ruminator). So I believe that there is REAL physical damage that we do to our brains.

Since I have now been through many cycles myself of OCD sickness and recovery, I've seen some patterns that make me think the physical "causes" of the disorder COULD be managed a little more like an actual physical disease-- kind of like the way that PTSD is being treated with beta-blockers.

My Hypothesis:
The OCD response could be short circuited at the ONSET of a spike with beta blockers like propranolol - much the same way that it's been researched with PTSD.
http://www.neuropsychiatryreviews.com/march02/ptsd.html

Once the part of the brain that forms our OCD "memories" or brain-lock is protected from the assault of epinephrine and the cortisol that follows, the disease may be easier to deal with.

I'm suggesting that OCD sufferers would go to their doctors soon after suffering a severe spike or triggering event and ASK for a beta-blocker like propranolol as a sort of prevention protocol- possibly followed by an anxiolytic.

I do not think that this would contradict any theories as to why some SSRIs work in alleviating OCD symptoms-- elevated serotonin makes a huge difference but doesn't take care of what I think is a basic problem with the etiology of OCD. Well, not the etiology for having the propensity for OCD- but a possible physical etiology for what sets off the anxiety/obsession/compulsion cycle.

I think that a part of our OCD brain (be it an OCD prone amygdala or whatever) gets "damaged" or overly sensitized by the constant flood of epinephrine and cortisone caused by initial spikes and triggers-- and the chain reactions begin.

I truly believe that the "living with uncertainty" method actually helps to retrain the brain back to "normalcy" because whatever connections get established to form the OCD responses-- become desensitized by exposure to the thoughts/things/situations that set us off. I use the four Rs (Relabel, Reattribute, Refocus, Revalue) AND the "uncertainty" method to retrain my brain. It takes a long time for particularly bad obsessions but it works.

But what if we OCD sufferers who are highly aware of our disorder would be able to fend off the cycles.

My 90s symptoms went away (or decreased tremendously) for seven years- until work-related stress, and some personal trauma-set me on an OCD bender that I'm recovering from with the uncertainty principle.

Yet, after reading much about PTSD, I am intrigued by the notion that we may be able to control the severity of our disease by viewing medications like beta-blockers as prophylactics against the disease.

Many OCD sufferers can pinpoint the moment, the thought, or the event that led to their current state- What if we had taken something like a beta-blocker that helped mitigate the repeated effects of epinephrine? I tell you this... when I've taken SSRIs RIGHT at the moments when I'm beginning an OCD bender-- I get worse. It's like the serotonin overexcites the brain at a moment when it's overly excited already. SSRIs seem to help once the cycle has settled into a pattern (spike-obsesss-compulse..etc) NOT when the initial huge anxiety spike begins.

What if the constant release of epinephrine EVERY time we begin to obsesses "consolidates" our OCD into "brain lock" the way it consolidates bad memories for PTSD sufferers?

This disease is pathetic- it make us afraid of living and can ruin our lives and WE know it--would anyone medical professional out there be willing to think about this... and discuss it with their peers?

As a professional specializing in treating anxiety disorders, I've worked with a number of clients with OCD. The most effective treatment I've found is using hypnotherapy. As you say, most people can trigger the exact moment that triggered their current state. In hypnotherapy, I'm able to help people live more comfortably in that doubt and not be so locked into that trigger moment you described.

I'm not at all familiar with the research you suggested on beta-blockers. I'm going to have to check into this, so thanks for pointing it out.

This is a good description of OCD. I have religions ocd known as scrupulosity and I literally don't get a moments restt from it. It plagues me every second im awake and sometimes the obsession compulsion cycle even invades my dreams. I ahve a good erp trained psyciatrist who has, allong with some medication, helped me alot. My OCD focuses on making me fear sin, and fear that in have sinned and gives me debilitating anxiety over it. If your suffering from anxiety, seek help. It's out there, and it works if you let it, though your anxiety may try to convince you that I thing will help, and it may even try to say it's a sin to seek it. It's not. God wants you to get better, He loves you, and doesn't want you to suffer. My OCD is trying to keep me from writing this post, which shows how strong it can be.